Commissioning Mental Health Services

GP-led commissioning does have the potential to improve both physical and mental healthcare for people with mental health problems – but only if certain conditions are met.

These conditions include:

the implementation of a national tariff for mental health care

GP-led consortia management allowances that allow for the hiring of high quality mental health commissioning expertise

effective commissioning partnerships between local GP-led consortia and the NHS Commissioning Board, which may be responsible for commissioning a range of specialist services for people with more severe mental health problems

an acknowledgement from GPs that mental health commissioning needs to reflect a social model of recovery, not just clinical care, and that good mental health commissioning must start with prevention and health promotion work

the outcomes against which GP-led consortia are measured must be designed in partnership with mental health service users and their families, as well as with partners in local authorities and employment, housing and welfare agencies.

We recommend the development of a toolkit for mental health commissioning specifically aimed at GP-led consortia and the NHS Commissioning Board, as planned by the National Mental Health Development Unit.

Background

The Coalition Government is planning radical changes to the way health services - including mental health services - are commissioned. Instead of the bulk of commissioning being undertaken by Primary Care Trusts (PCTs), responsibility is to move to local GP consortia (or the NHS Commissioning Board for more specialist services). The changes were outlined in the White Paper Equity and Excellence: Liberating the NHS (July 2010) and Liberating the NHS: Legislative Framework and Next Steps (December 2010) and will be implemented through the Health and Social Care Bill (introduced to Parliament in January 2011).

The question is: how will GP consortia develop the skills and expertise that will allow them to become expert mental health commissioners?

Widespread concerns about the quality of PCT commissioning underpin the Coalition Government’s proposals. Certainly within PCTs mental health commissioning remains underdeveloped in many areas, often with those responsible not having a background in mental health, or doing it only as part of their job, or being relatively inexperienced. Most expertise continues to reside within secondary care providers, so local mental health trusts dominate local service provision. This is not to say that there are not some expert mental health commissioners within PCTs – but it is a patchy picture across the country. Alongside this, there is evidence that some GPs themselves do not feel they have all the expertise they would like to commission the most cost-effective and evidence-based mental health services that will lead to the best outcomes for their patients.

GP commissioning is not new - previous attempts to introduce it to the NHS have included GP Fundholding (1991-1997), and Practice-based commissioning (2005 to present). A King's Fund overview of these arrangements suggests that the former created high transaction costs and a two-tier system in access to care and the latter had little impact in terms of improving use of resources opr providing better services.